Itemized Bill Review (IBR) Program for Medicare Advantage Business

In a continuing effort to manage and control health care costs on behalf of our members, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will implement a new Itemized Bill Review (IBR) program effective January 1, 2024, for the Medicare Advantage line of business for all claims with charge amounts equal to or greater than $100,000.

This Blue Cross NC Medicare Advantage IBR program is being implemented to maintain accuracy in claims payments by ensuring claims are not overpaid or underpaid. The IBR program claims reviews will be conducted on a pre-payment and post-payment basis, with post-payment reviews applying to claims paid within the past 18 months.